ER visits on the rise due to Medicaid expansion

Emergency room visits are on the rise in states that expanded Medicaid, according to a nationwide study conducted by the Colorado Hospital Association (CHA).

The average number of emergency department (ED) visits to hospitals in expansion states jumped 5.6 percent from second quarter 2013 to second quarter 2014, the report said. Researchers said the change was greater than they expected from the variation over the last two years and resulted in the highest number of average visits over the time.

In comparison, hospitals in states that refused to expand Medicaid reported a 1.8  percent increase in ED visits in the same time period.

Study authors said the rise in ED visits in states that didn't expand Medicaid are likely the result of the woodwork effect, where previously unenrolled individuals discover that they are eligible for Medicaid--probably due to the individual mandate requirement or from outreach and media coverage of health reform.

The CHA study findings are similar to the results of a January study in Science that found an increase in insured hospital patients due to Medicaid expansion led to a 40 percent rise in their visits to the emergency room (ER).

In addition to the national study, CHA conducted a Colorado-specific analysis that indicated that the newly-insured Medicaid patients have more complex conditions than the average Medicaid patient previously seen at the hospital EDs. The case mix index, which measures complexity and resource needs, increased 10 percent for Medicaid patients in the first quarter of 2014 as compared to first quarter 2013. Furthermore, the number of Medicaid-covered ED visits increased 38 percent in first quarter 2014.

"Hospitals located in expansion states are serving greater numbers of Medicaid patients, many needing care for advanced chronic health conditions that were previously left untreated," Steven J. Summer, CHA president and CEO said in a statement announcing the study results. "These findings confirm that individuals who previously had no insurance coverage are now seeking and receiving healthcare services--and their needs are great."

But not all newly insured are heading to the ER. A new study in Health Affairs finds a drop in ER use among young adults who are now eligible for health insurance under the Affordable Care Act (ACA). The study looked at 2009-2011 state administrative records from California, Florida and New York to compare changes in ED use in young adults ages 19-25 before and after the ACA provision took effect with changes in the same period for adults ages 26 to 31.

Following implementation of the ACA, the younger group had a decrease of 2.7 ED visits per 1,000 people compared to the older group--a relative change of -2.1 percent. Authors say the decrease implies a total reduction of more than 60,000 visits from younger adults across the three states in 2011. But when they compared the probability the young adults would use the ED before and after implementation of the ACA, researchers say there was a minimal decrease among the younger group compared to the older group. "This suggests that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED," researchers conclude.

To learn more:
- read the CHA study and announcement
- here's the Health Affairs study

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